Corticosteroids
Topical corticosteroids remain the cornerstone of ocular anti-inflammatory
therapy.
Next to refractive error and dry eye, inflammatory conditions
represent the most common clinical challenges. It is imperative
that optometrists become familiar with the various topical
steroids, and become competent and comfortable in their clinical
use.
It’s also critical that clinicians overcome the myths that
surround the use of steroids, most notably that they pose a
great risk of elevated intraocular pressure. Studies show that
significant ocular hypertension is unlikely to occur before
three to five weeks of prolonged topical steroid use even in
known “steroid-responders,” yet most cases of ocular inflammation
are resolved well within this time frame.
Topical steroids are safe and effective agents that are useful
in treating a host of ocular inflammatory conditions. Indeed,
far more harm has come from withholding steroids than has occurred
from their use. The risks associated with short-term use are
minimal, yet the therapeutic benefits are significant. The
addition of loteprednol etabonate has further widened the window
of safety in topical therapy.
Selecting the Proper Drug
There are a number of topical steroids available, and making
the proper selection may be confusing.
We recommend that you streamline your choices to a handful
of safe and effective agents, and tailor your selection to
the severity of the case.
- For moderate to severe inflammation, we recommend using
one of four essentially equivalent maximum-efficacy steroids:
loteprednol etabonate 0.5% (Lotemax),prednisolone acetate
(Pred Forte), prednisolone sodium phosphate (Inflamase Forte),
or rimexolone (Vexol).
- For mild to moderate inflammatory conditions, the fluorometholones
work well. Remember that the acetate form (such as Flarex or
eFlone) possesses greater anti-inflammatory activity than the
alcohol form (FML), mainly through enhanced bioavailability.
- When you need overnight suppression of inflammation or
are treating contact dermatitis, prescribe fluorometholone
(FML) ointment. If the pharmacy does not have FML ointment
available, a combination antibacterial/corticosteroid such
as TobraDex will have to be dispensed. We are still unable
to find any company that produces dexamethasone ophthalmic
ointment.
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